Impact of acute chest pain Tc-99m sestamibi myocardial, perfusion imaging on clinical management

Background. Previous studies have demonstrated the high sensitivity and specificity of technetium 99m sestamibi scintigraphy during acute chest pain myocardial perfusion imaging. However, no study has shown that this technique would alter clinical management in practice. Methods and Results. One hundred twenty consecutive patients were injected with Tc-99m sestamibi (22 mCi) during pain; single photon emission computed tomography was performed 1 to 6 hours later. The population included inpatients and those who arrived at the emergency department with chest pain deemed to be at intermediate risk for myocardial ischemia. The requesting physician completed a questionnaire before the study, indicating the likelihood of cardiac disease and proposed management had the test not been available. Follow-up management was evaluated from medical records. There was a 34% reduction in total admissions and 59% in planned admissions to the coronary care unit (P < .001). Conversely, 7 patients had discharge cancelled and 17 required coronary care purely because of abnormal acute rest myocardial perfusion imaging results. Coronary angiography was reduced by 40% in a selected subgroup. Conclusions. In our population, acute rest myocardial perfusion imaging reduced total admissions and altered resource utilization. This may result in more appropriate triage of individual patients in the management algorithm, as well as potential cost savings. (J Nucl Cardiol 2002;9:257-62.).